Pat Buckley (Cork East, Sinn Fein)
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There has been a decision by the HSE to cap the number of transitional care beds that it funds for patients waiting for places in nursing or convalescent homes. In the Cork and Kerry region, as the HSE has stated, the knock-on effect of this would be that it would add to bottlenecks in acute hospitals. HSE officials have indicated that this will result in additional delays to discharges. We already know that the HSE does not have the bed capacity in acute or community hospitals to manage the volume of patients requiring care. It is all to save money and balance the budget. The national care office has stated that if it is to reach a break-even position, unfortunately there is no choice. In creating another waiting list, what will be the outcome for these people? What impact will there be on the nursing home system and hospital system, and what is going to be the overall impact on society? Last week, Sinn Féin received cross-party support in respect of a Private Members' motion for significant change to elder care provision. There are over 6,000 people already on waiting lists for home help. I appeal to senior HSE management to stop now and to reverse the decision to cap services for the sake of money.

Martin Ferris (Kerry, Sinn Fein)
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Everybody in this House recognises the importance of the fair deal scheme and that it has served our society so well in the past. The €30 million deficit in the scheme this year is having a detrimental effect. The consequences are that beds in hospital for people who are ill are being taken by healthy patients. I refer to elderly individuals who are in hospitals and have nobody to take them home. They are kept in hospital because of a lack of funding in order to ensure that the fair deal scheme can be operated and to take that pressure off it. There is an impact on the nursing homes as well with beds vacant and no funding there to take people who would be qualified applicants. At the moment there are 6,000 people on the waiting list for home help. There is a lack of resources for home help packages. The number of people over 65 years of age is increasing by 20,000 each year. More and more people will be looking for nursing home packages and the resources have to be put in place to meet that demand as a priority.

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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A lot of what is happening runs contrary to what the Government says it wants to do and what it says is needed, namely, taking the pressure off the acute system and investing in community care, home care and nursing homes. However, we see a cut in respect of new people getting home help. There has also been a cut to the number of transitional care beds and there are issues regarding potential capital projects as well. This is going to cause serious problems, and not only for nursing homes and patients. It is going to put further pressure on the acute system further up the chain. If these beds are not provided, a significant number of people will not be able to leave hospital to go into a transitional care bed and on into a nursing home. Investment in community care and community health facilities is being undermined and it is going to have a real impact.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputies Buckley, Ferris and Ó Laoghaire for raising this very important issue. I shall take this matter on behalf of the Minister of State, Deputy Jim Daly.

The overarching policy of the Government is to support older people to move to a more appropriate care setting following treatment in acute hospitals and ultimately either to return to live as independently as possible in their own homes and communities, or for those who need it to move to residential care.

The National Service Plan 2019 provides an overall financial allocation of €1.8 billion of which €862 million is available for older persons' services and more than €985 million is available for the nursing home support scheme. In 2019 some 53,000 people will receive 17.9 million home support hours. This includes supporting 550 patients to leave hospital over the winter period. A further 235 people will receive 360,000 hours through intensive home care packages. More than 10,900 people will be supported to leave hospital through transitional care funding. We take this important issue very seriously.

The provision of transitional care beds assists with patients in acute hospitals who are ready for discharge, but who need nursing home care or a period of convalescence up to a maximum of four weeks. The scheme funds these patients in private nursing home beds, thereby facilitating the discharge of the patients from the acute setting and allowing their beds to be used for other patients. The system of transitional care provision has been in place since 2015 and is available to all public hospitals in the State.

Under the HSE’s National Service Plan 2019, a budget of €28.5 million has been allocated to support discharges from acute hospitals to transitional or step-down care. Despite this significant level of funding and service provision, the demand for services continues to grow. The allocation of funding across the system, though significant, is finite and services must be delivered within the funding available.

Up to May 2019, approvals were being allocated on a demand-led basis, as requests for this type of care normally tend to decrease over the summer months. This, however, has not been the case in 2019 and the number of requests for transitional care has continued to increase. The highest expenditure for the year occurred in the months of April and May 2019. The waiting time for transitional care at present is approximately one week. As of today, there are 23 people on the waiting list for transitional care funding who have applied for the fair deal scheme.

Transitional care funding is a national support service and there is no specific allocation for any region such as the Cork/Kerry Community Health Organisation. It is administered taking account of the available resource envelope, with funding distributed accordingly across the regions over the entire year. By the end of May, funding approval was provided for 378 transitional care beds in CHO 4. Preliminary data from June indicates that about a further 60 approvals were provided for CHO 4 in that month.

The HSE is required to deliver services within its available budget. To ensure there is sufficient funding available for the remainder of the year and to ensure that expenditure is in line with the transitional care funding allocation at the end of the year the HSE is managing its allocation of funding approvals having regard to the significant volume of approvals released in the first five months of the year. This means that since the start of June the rate of approvals has reduced compared to the early part of the year. Approvals will continue to be monitored closely and funding will be adjusted on a monthly basis to ensure a balanced budget for 2019.

Pat Buckley (Cork East, Sinn Fein)
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I thank the Minister of State for his reply. I do not have much time so I will touch on just two points, the first being that once again we are talking about money versus people. The Minister of State appears to be very supportive of the Sláintecare report, the introduction to which states that patients are treated on the basis of need rather than means. It should not be a money thing.

In his reply the Minister of State said that "Preliminary data from June indicates that about a further 60 approvals were provided for CHO 4 in that month." I had learned that it was actually in June when the social care division started to cap the transitional care approvals. I am not sure whether or not these are the blank cheques or the thanks one cashes in the banks. The Minister of State's reply also said that "the rate of approvals has reduced compared to the early part of the year." Of course it has, when they have capped it; nothing is happening.

We want this situation resolved. How we are currently treating our elderly people is disgraceful. We know there is another tsunami coming down the road.

Martin Ferris (Kerry, Sinn Fein)
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Angela Fitzgerald, a senior manager overseeing acute hospitals, has highlighted a growth in delays releasing healthy patients from hospitals. She has said that a National Service Plan 2019 target of having fewer than 550 beds subject to the so-called "delayed discharge" is being missed. This is Ms Fitzgerald saying this, not me. The number recorded from Ms Fitzgerald's briefing from April stood at 639. Ms Fitzgerald has said that further deterioration was expected due to a funding limit. It is basically coming down to funding being made available.

The Minister of State said:

Under the HSE's National Service Plan 2019, a budget of €28.5 million has been allocated to support discharges from acute hospitals... Despite this significant level of funding and service provision, the demand for services continues to grow.

Obviously, the money available for this is not adequate to meet demand. Beds are badly needed in hospitals for seriously ill patients but no beds are available because they are being taken up by healthy patients who are waiting for a discharge. This is inexcusable and it needs to be looked at further.

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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The Minister of State will, I have no doubt, be aware of how severe the situation is in our hospitals, even in the middle of summer. Dr. Conor Deasy of Cork University Hospital, CUH, is reported in The Echo this week as saying that some 300 deaths per year can be partially attributed to overcrowding in our hospitals. There were 834 people on trolleys in CUH in June. It is absolutely incredible. A big factor is that nearly 54% of the bed capacity is taken up by 10% of patients. This is through no fault of their own. It is due to a lack of a place for the patient to go to. This scheme would allow those patients to get into nursing homes. The fair deal scheme is complicated, it can take time to bring things together and some people may not qualify for it. This scheme allows people, where they are fit and healthy, to leave hospital to go into another bed. The scheme should be funded adequately to ensure that every available nursing home bed, through whatever scheme, is taken up and that every potential space in the hospital system is created. As with home help, this scheme is not being funded properly. If it was funded properly it would ensure that pressure is taken off the acute system.

Finian McGrath (Dublin Bay North, Independent)
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I take on board the points raised by the Deputies and I will bring them to the Minister of State, Deputy Jim Daly. A person who has a delayed transfer of care is a person who has been deemed clinically fit for discharge from the acute bed, but whose discharge is delayed because he or she is waiting for some form of ongoing support or care following the discharge. There has been a substantial focus in recent years on reducing the delayed transfer of care, commonly known as delayed discharges, and enabling patients to be discharged from hospital sooner. This year the HSE aims to support some 10,900 people to leave hospital through the transitional care funding. Between 1 January and 31 May there were 4,861 approvals nationally, equating to approximately 231 per week, which is 20 per week ahead of target.

Given the increase in approvals over the first part of the year, approval rates must now reduce during the summer months to ensure the service stays within its budget.

Deputy Buckley spoke of the needs of patients, which absolutely must be addressed in line with Sláintecare. Deputy Ferris pointed to the figure of €28.5 million in funding. Deputy Ó Laoghaire referred to deaths and overcrowding, which is not acceptable. We also have to deal with the bed capacity issue. The plan is to invest in more capacity in our health service.

The Independent Expert Review of Delayed Discharges report was published in November. The review recognised the points raised and that delayed discharges are caused by a multitude of factors. The review made nine recommendations that include the development of a national policy to provide for a more consistent approach to recording delayed discharges, strengthening data collection, standardising the definitions and ensuring consistent discharge guidelines.

Following publication of the report immediate focus was on reducing delayed discharges as we entered the winter season through mobilising additional resources that were made available and in ensuring that social care measures were effected without delay.

I will bring the points raised to the attention of the Minister of State, Deputy Jim Daly. We need to develop the services and deal with the capacity issue.